GAO: Trump-Era Hospital Reporting Program Incomplete, Burdensome

Inside Health Policy

August 6, 2021 9:26 pm

Public health officials and epidemiological associations are often not using COVID-19 data gathered through the Trump-era controversial HHS hospital reporting program, opting instead for state and local datasets that are more detailed, the Government Accountability Office found in a report ordered by Democratic lawmakers who worried the Trump administration set up the HHS program to bypass the Centers for Disease Control and Prevention in order to manipulate the data.

But HHS officials say at least five states rely on the HHS data and the program has helped the government identify which hospitals have personal protective equipment and other supply shortages.

Hospitals were reporting COVID-19 cases through CDC’s National Healthcare Safety Network until July 10, when HHS officials told them to report only through its new program HHS Protect. The move prompted immediate outcry from several Democrats, including Rep. Rosa DeLauro (D-CT) who accused HHS as “operating as a dangerous, political apparatus.”

House Energy & Commerce Chairman Frank Pallone (D-NJ), along with two colleagues, asked the GAO on Aug. 19, 2020 to determine the timeline, effect on the pandemic response and data quality control measures since hospitals stopped reporting to the CDC.

Shortly after the letter, the Trump administration introduced an interim final rule that made reporting to HHS Protect a requirement to participate in Medicare and Medicaid. The move signaled hospitals would be removed from the programs if they didn’t report the number of confirmed or suspected COVID-19 positive patients, occupied ICU beds and the availability of essential supplies.

Then-HHS Secretary Alex Azar painted his department’s hospital COVID-19 data reporting program as a model for the future of data collection before he left office on Jan. 20.

The GAO released its findings Thursday (Aug. 5) and found constantly evolving, incomplete guidance that made it hard for hospitals to comply. One such challenge was the lack of an initial data dictionary for how to report hospital capacity, prompting questions about the definition of an intensive care unit bed and whether to include nursery beds in their reports.

The report also found HHS Protect increased administrative burden on hospitals more than HHS’ estimate of 1.5 hours each day. Stakeholders reported the department’s estimate didn’t take into account that reporting can involve multiple staff and require pulling data from multiple sources.

The GAO also found epidemiological associations and state and local health officials often preferred to use their own data, which are more tailored to their needs.

“HHS Protect requires hospitals to report on the number of beds in use, and officials from one state told us they asked instead for the number of beds available, which provided more pertinent information for their purposes,” the GAO report says. “They also told us that the state had implemented an automated feed from hospitals to provide bed utilization data every 10 minutes, giving the state more timely information on hospital capacity.”

But HHS says a handful of states use their data and the program enabled the department to alert states to 2,600 supply and staff shortages, of which about 1,500 were resolved. Another 100 instances required federal support and the remaining were validated, but no further action was needed.

HHS told the GAO it plans to use HHS Protect to create a long-term all-hazards system that quickly adapts to gather data for future public health emergencies. Meanwhile, the CDC emphasized the need for HHS to include CDC staff to ensure the program’s data are complete and useful.

HHS says it’s addressing part of the GAO’s recommendation that it provide on-going discussions with hospitals and public health officials, but it has yet to establish an expert committee due to COVID-19 and resource constraints.